I agree that the American Academy of Pediatrics may use and permit other persons to use the information, negatives, prints, or videos prepared as a result for such purposes and in such manner as it may deem appropriate, including but not limited to, medical, educational and scientific journals, newspaper and magazine articles, television, movies, websites, or any other media or means of dissemination.

I verify I am the parent or the legal guardian of the child(ren) depicted in the video and I authorize the American Academy of Pediatrics to use the video provided by  me for the use specified herein.

I also authorize and consent to the use of video taping, preparation of drawings and similar illustrative graphic material, and the use of these materials for scientific purposes.

I agree that the American Academy of Pediatrics will be the sole and exclusive owner of such materials. I release the information that I provide to the American Academy of Pediatrics, and I understand that any dissemination of the materials described above, which are made public, will be within generally accepted bounds of good taste.

The terms "photograph", "photographs" or "video" as used in the foregoing shall mean motion picture or still photography in any format, as well as videotape, videodisc, or any other mechanical means of recording and reproducing images.

Release of Liability

I hereby waive any right to compensation for such uses by reason of the foregoing authorizations, and hereby release the American Academy of Pediatrics and their officers, agents, employees, successors, and assigns harmless from and against all claims of liability with respect to the showing, use, or dissemination of the photographs/videos or otherwise resulting from the activities authorized by this agreement.